No Link Seen Between Antihypertensive Therapy and Diabetes Risk

The risk of type 2 diabetes does not appear to be increased or decreased in elderly hypertension patients who use any of the major classes of antihypertensive medications. In a retrospective, observational cohort study of previously untreated elderly patients, Dr. Raj Padwal, of the University of Alberta Hospital, Canada, and colleagues examined whether the incidence of type 2 diabetes differed among new users of the major antihypertensive drug classes.

A total of 35,993 subjects were on ACE inhibitors, 20,585 were on beta-blockers, and 19,598 were receiving calcium channel blockers, with thiazide diuretics allowed as an add-on therapy. A secondary analysis included thiazide diuretics as a fourth study group.

More than half of the subjects (53%) were excluded from the analysis because of medication discontinuation, and 17% were dropped from the study after another medication was added.

After adjusting for covariates, neither ACE inhibitor use (hazard ratio [HR] 0.96) nor beta-blocker use (HR 0.86) was associated with a significant difference in type 2 diabetes incidence compared with patients receiving calcium channel blockers.

The secondary analysis cohort included 27,209 patients taking ACE inhibitors, 15,575 on beta-blockers, 15,534 calcium channel blockers users, and 42,335 patients in the thiazide diuretic group.

Similar to findings in the first analysis, in the secondary analysis the incidence of type diabetes was not significantly different among users of any of the antihypertensive drugs.

"Until this issue is clarified by ongoing randomized controlled trials and future research, we suggest that clinicians guide their choice of initial antihypertensive therapy on the basis of more established factors, such as the available evidence regarding efficacy, economic considerations, and the presence of comorbid medical conditions," the researchers conclude. Diabetes Care 2004;27:2458-2463.